Proximal fibular osteotomy for medial compartment knee osteoarthritis: A prospective cohort study in a Western population

Proximal fibular osteotomy (PFO) is an emerging joint-preserving procedure for medial compartment knee osteoarthritis (OA), with most evidence derived from East Asian populations. Its safety and efficacy in Western patients remain underexplored. This prospective single-centre study, conducted at a tertiary university hospital in Greece (Southern Europe), evaluated 27 patients (30 knees) with medial compartment OA or knee OA with predominantly medial symptoms who underwent PFO. Primary outcomes were changes in VAS pain, Knee Society Score (KSS), Oxford Knee Score (OKS), KOOS-Jr, and EQ-5D-5 L at 12 months. Secondary outcomes included postoperative complications and conversion to total knee arthroplasty (TKA). At 12 months, all outcomes improved significantly from baseline (<i>p</i> < 0.001), exceeding established minimal clinically important differences: VAS -4.4, KSS +27.9, OKS +14.8, KOOS-Jr +20.6, EQ-5D-5 L + 0.27. One knee (3.3%) converted to TKA due to persistent pain. Peroneal nerve-related symptoms occurred in 36.7% of knees but resolved by 6 months. In this European (Greek) cohort, PFO provided substantial pain relief, functional improvement, and quality-of-life gains at 12 months with a favorable safety profile. These findings align with prior reports from East Asian populations and suggest that PFO may be a viable minimally invasive option for carefully selected Western patients with mild-to-moderate varus OA and medial compartment symptoms. Further high-quality research is needed to confirm these results and define PFO's role in knee OA management.